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Sundowning May Explain Mood Changes in Dementia Patients

For patients suffering from Alzheimer’s disease or other forms of dementia, it’s common to display changes in mood or behavior, especially in the late afternoon or early evening. These changes can include substantial mood swings, accompanied by confusion, a set of behaviors that is referred to as “sundowning” because of the time of day it takes place. And while there are more questions than there are answers about sundowning, it is estimated to affect as many as two-thirds of all people with dementia.

In addition to confusion, the symptoms of sundowning can include restlessness, irritability, and agitation. It typically starts in the late afternoon and is thought to be triggered by the setting sun, which means less light from outside and more prominent shadows. Sundowning can continue well into the evening, coinciding with the time that caregivers usually start to get tired and need a break.

There are plenty of signs you can look for that indicate sundowning, such as increased anxiety or confusion, as well as wandering, pacing the floor, or yelling. The patient may also become very demanding and even suspicious of caregivers and family members. They have also been known to hallucinate, seeing or hearing things that don’t exist.

Researchers are not exactly sure why sundowning occurs, but it seems to be triggered by fading light. Some scientists believe that the inner biological clock of dementia patients may be affected by the disease causing their dementia, which could cause problems with sleep cycles and explain why the condition is connected to the time of day.

Other factors seem to aggravate and may trigger sundowning among dementia patients, including fatigue, hunger, dehydration, depression, physical pain, and boredom. There is also some speculation that, with the setting sun, shadows increase and change, causing confusion and anxiety.

For patients living in an assisted-living or long-term care facility, there is often a spike in activity in the late afternoon with a shift change, which can increase the anxiety level in dementia patients. This activity may also prompt some dementia patients to want to go home or do the kinds of things they used to do at that time of day in the past.

What you can do

While it’s unlikely that you’d be able to completely stop it, there are steps you can take to manage your loved ones during sundowning episodes. For the most part, it means removing the triggers that lead to this behavior, or at least minimizing their impact.

For example, establishing a daily routine with set times for waking, meals, and going to bed, can lessen the anxiety and confusion they might experience. It’s also a good idea to schedule appointments, visits, and other similar activities for earlier in the day. You should also limit or completely avoid things that negatively affect sleep, such as smoking or drinking alcohol. And limit the amount of caffeine and sugar dementia patients consume.

Finally, it’s important for caregivers to take care of themselves, which is often overlooked. When you have a loved one who is a dementia patient, it can be very stressful because their behavior is sometimes unpredictable. When the person you are caring for is experiencing sundowning episodes, it can even be difficult to get a good night’s sleep.

So consider asking another family member or close friend to fill in for you, especially at night so you can sleep. It may also be worth it to hire a home healthcare service or private nurse to give you a break. Get some exercise, eat healthy food, socialize with friends, and make time for your own hobbies and interests. You may also want to look into joining a caregivers’ support group so you can talk to others going through similar experiences.


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